Thrombus Aspiration during Percutaneous coronary intervention in Acute myocardial infarction Study (TAPAS) Mortality and reinfarction at 1 year

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Thrombus Aspiration during Percutaneous coronary
intervention in Acute myocardial infarction Study
(TAPAS)Mortality and reinfarction at 1 year

• F. Zijlstra, MD PhD
• Thoraxcenter
• University Medical Center Groningen,
• The Netherlands

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Presenter Disclosure Information
Disclosure InformationThe following
relationships exist related to this presentation
Tone Svilaas No disclosures Pieter J.
Vlaar No disclosures Iwan C. van der
Horst No disclosures Gilles F.H. Diercks No
disclosures Bart J.G.L. de Smet No
disclosures Ad F.M. van den Heuvel No
disclosures Rutger L. Anthonio No
disclosures Gillian A. Jessurun No
disclosures Eng-Shiong Tan No
disclosures Albert J.H. Suurmeijer No
disclosures Felix Zijlstra No disclosures
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TAPAS Background

• Myocardial perfusion after primary PCI determines
  clinical outcome
• Embolization of atherothrombotic material plays a
  crucial role in microvascular obstruction and
  impared myocardial perfusion
• Previous trials have shown the feasibility of
  thrombus aspiration during primary PCI

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TAPAS Methods (1)

• Single center, prospective, randomized
• Consecutive patients with STEMI
• Primary endpoint
• Myocardial blush grade (core lab)
• Secondary endpoints
• ST-segment elevation resolution
• 30 day death and death / reinfarction
• 1 year death and death / reinfarction

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TAPAS Methods (2)

• Randomization before angiography to thrombus
  aspiration or conventional PCI
• Exclusion criteria
• Rescue PCI after thrombolysis
• Life expectancy lt 6 months
• Standard treatment
• Heparin, aspirin, clopidogrel, abciximab
• Intention to treat analysis

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1071 STEMI patients randomized
535 were assigned to thrombus aspiration
536 were assigned to conventional PCI
33 did not undergo PCI 502 underwent primary
PCI 295 underwent TA followed by direct
stenting 153 underwent TA with additional balloon
dilation 54 had crossover to conventional PCI
33 did not undergo PCI 503 underwent primary
PCI 485 underwent balloon dilation followed by
stenting 12 underwent conventional PCI with
additional TA 6 had crossover to TA
530 complete follow-up at 1 year
530 complete follow-up at 1 year
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Baseline clinical characteristics
Characteristic Thrombus aspiration N 535 Conventional N 536
Age, years 6313 6313
Male gender 68 73
Body mass index 274 274
Hypertension 33 37
Family history 46 45
Diabetes 11 13
Hypercholesterolemia 24 27
Current smoking 46 48
Previous MI 10 11
Total ischemic time (min) 190 (110-270) 185 (107-263)
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Baseline angiographic characteristics
Characteristic Thrombus aspiration N 535 Conventional N 536
Infarct related vessel
LAD 43 43
LCX 18 15
RCA 37 40
Multivessel disease 66 69
TIMI flow grade
0 or 1 55 60
2 19 16
3 26 25
Thrombus 49 46
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Primary endpoint Myocardial blush grade
P lt 0.001
Patients ()
Thrombus aspiration
Conventional PCI
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ST-segment elevation resolution
P lt 0.001
Patients ()
Thrombus aspiration
Conventional PCI
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Myocardial blush grade and death or
death/reinfarction at 30 days
P 0.001
Myocardial blush grade
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TAPAS Summary of findings at 30 days

• Thrombus aspiration results in improved
  myocardial reperfusion
• Myocardial blush grade predicts 30 day rates of
  death and reinfarction
• Does improved myocardial reperfusion translate
  into clinical benefit at 1 year?

?
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TAPAS one year outcome Myocardial blush grade
and death or death/reinfarction at 1 year
P 0.001
Myocardial blush grade
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Mortality at 1 year
Log-Rank p 0.040
Unpublished results
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Mortality or non-fatal ReMI at 1 year
Log-Rank p 0.016
Unpublished results
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TAPAS Mortality and reinfarction at 1 year

• Myocardial blush grade predicts clinical outcome
  at 1 year
• Thrombus aspiration results in a lower mortality
  and combined mortality and non-fatal reinfarction
  at 1 year

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Presenter Disclosure Information
Thrombus aspiration during primary percutaneous
coronary intervention
Disclosure InformationThe following
relationships exist related to this presentation
Tone Svilaas No disclosures Pieter J.
Vlaar No disclosures Iwan C. van der
Horst No disclosures Gilles F.H. Diercks No
disclosures Bart J.G.L. de Smet No
disclosures Ad F.M. van den Heuvel No
disclosures Rutger L. Anthonio No
disclosures Gillian A. Jessurun No
disclosures Eng-Shiong Tan No
disclosures Albert J.H. Suurmeijer No
disclosures Felix Zijlstra No disclosures